Investing in Primary Care to Ensure High-Quality Care for All Americans

The COVID-19 pandemic has shone a light on the grave consequences of underinvestment in primary care and primary care research. Although we have known for decades that health systems with a strong foundation in primary care can improve access to care, health outcomes (including reduced mortality), and health equity, important work remains to be done.

There is, however, much cause for optimism as momentum grows for greater investments in primary care. Last year’s RAND report, commissioned by AHRQ, provides meaningful insights for maximizing the impact of primary care research findings and encouraging research innovation.

The recent National Academy of Sciences, Engineering, and Medicine report, Implementing High-Quality Primary Care, which AHRQ co-sponsored, provides a roadmap for enabling primary care to achieve its potential. AHRQ is committed to supporting implementation of the report’s conclusions and recommendations.

The good news is that the President’s FY 22 budget proposal includes robust endorsements for this work for the first time in many years.  It supports the congressionally mandated AHRQ National Center for Excellence in Primary Care Research (NCEPCR) by including $10 million for primary care research and $7 million for improving the management of substance abuse in primary care and other ambulatory settings.  The House of Representatives has also included dedicated funding for primary care research in the FY22 budget. This funding, if approved by Congress and signed by President Biden, will allow these critical initiatives to continue. The timing could not be better for AHRQ to welcome a new director of NCEPCR, Dr. Patrick O’Malley, who will have an important role in leading AHRQ’s future primary care research investments.

As the only Federal agency specifically charged with conducting and supporting primary care research, AHRQ has built a robust portfolio of primary care research. The results have had important impacts on everyday practice.

• AHRQ’s EvidenceNOW initiatives are engaging primary care practices across the country to help them incorporate the best evidence into patient care, while at the same time generating the critical evidence needed to transform primary care. The Advancing Heart Health initiative boosted the capacity of primary care practices to improve quality of care, while achieving measurable improvements in  cardiovascular risk reduction, including smoking cessation and hypertension control.  
• Insights from this initiative informed our new initiative, Building State Capacity-Advancing Equity in Heart Health, which is working in States with the highest rates of heart attack and stroke to help practices improve care, address health equity, and foster linkages between primary care and public health.
• Managing Unhealthy Alcohol Use, another EvidenceNOW primary care initiative, is working with practices to increase screening and brief intervention for risky drinking and use of medications to treat alcohol use disorder when indicated.
• AHRQ’s research is helping us learn how to effectively integrate behavioral health and primary care. AHRQ’s Integrating Behavioral Health and Primary Care Playbook provides a guide for improving patient care by addressing behavioral health and medical conditions, preventing fragmentation between behavioral health and medical care, and building relationships with mental health specialists outside the primary care setting.
• AHRQ’s initiative on Opioid Use in Older Adults, which will provide important lessons on avoiding harms in this under-recognized and high-risk population, includes a focus on the role of primary care. AHRQ continues to have a strong interest in research to prevent, identify, and treat substance use disorders to stem the epidemic of deaths and harms from opioid and polysubstance use in all population at risk.
• To help primary care practices address the ongoing opioid epidemic in rural areas, AHRQ’s medication-assisted treatment (MAT) initiative provided insights into how to increase delivery of MAT through innovative technology, including patient-controlled smartphone apps, and remote training and expert consultation using Project ECHO. AHRQ’s Medication-Assisted Treatment for Opioid Use Disorder Playbook serves as a comprehensive guide for implementing MAT in primary care and other ambulatory care settings.
• Improving safety in all healthcare settings is a priority for AHRQ and the Agency’s patient safety portfolio includes research and tools to help make primary care safer for patients. Current funding opportunities encourage efforts to address safety in primary care, and resources like TeamSTEPPS for office-based care and patient and family engagement in primary care can be readily incorporated by primary care practices.
• AHRQ empowers patients as well through its research on patient-centered shared decision making, which provides evidence-based information about available options, the provider's understanding, and the patient's preferences.
• Finally, recognizing the drastic effect the pandemic has had on the delivery of healthcare, AHRQ has funded 28 research grants to address essential questions about the impact of COVID-19, including the response of the primary care system. The PROMIS Learning Lab is studying the disruptions in primary care that occurred due to COVID-19. Another grantee is examining the responses, challenges, and capacity of primary care practices made during the pandemic.

In the wake of COVID-19, vital questions have been identified about how primary care can most effectively support the Nation’s ongoing recovery from the pandemic: What efforts must be made to help patients who have missed preventive care? How can patients’ multiple chronic conditions be effectively managed to optimize health outcomes? What approach is required to adequately vaccinate the population?

The future of primary care remains uncertain, but the need to act is not. AHRQ’s past, present, and future primary care research can help guide primary care’s capacity to not only adapt to the ever-evolving pandemic but to address broader challenges to the Nation’s healthcare.

AHRQ will continue to fund research which can answer critical questions needed to deliver high-quality primary care, develop tools and resources to help primary care clinicians improve patient care, and produce data and insights to understand the state of primary care and opportunities for intervention.

Arlene Bierman is Director of AHRQ’s Center for Evidence and Practice Improvement. Bob McNellis, M.P.H., P.A., is AHRQ’s Senior Advisor for Primary Care.

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